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Prolonged antibiotic prophylaxis in patients with bilioenteric anastomosis undergoing percutaneous radiofrequency ablation


Hoffmann, Rüdiger; Rempp, Hansjörg; Schmidt, Diethard; Pereira, Philippe L; Claussen, Claus D; Clasen, Stephan (2012). Prolonged antibiotic prophylaxis in patients with bilioenteric anastomosis undergoing percutaneous radiofrequency ablation. Journal of Vascular and Interventional Radiology, 23(4):545-551.

Abstract

PURPOSE: To reduce risk of development of a hepatic abscess in patients with preexisting bilioenteric anastomosis (BEA) undergoing radiofrequency (RF) ablation of hepatic tumors by use of prolonged antibiotic prophylaxis over at least 10 days.
MATERIALS AND METHODS: Between April 2003 and June 2011, 184 patients underwent 206 percutaneous RF ablation procedures for hepatic malignancies. Eight patients presented with BEA and were treated in 10 sessions at 14 tumor locations. These 8 patients were male and ranged in age from 55-73 years. Median follow-up was 34 months. Antibiotic prophylaxis was given before the intervention (n = 9, piperacillin/tazobactam; n = 1, ciprofloxacin). Oral antibiotic prophylaxis after the intervention was continued with ciprofloxacin for at least 10 days. In four cases, prophylaxis after the intervention was extended with additional antibiotics.
RESULTS: A liver abscess occurred 22 days after 1 of 10 RF ablation sessions in patients with preexisting BEA. The patient who developed an abscess presented with a large hepatocellular carcinoma (59 mm × 54 mm) and underwent transarterial chemoembolization 8 days before RF ablation. No hepatic abscess occurred after 196 RF ablation sessions in 176 patients without BEA.
CONCLUSIONS: Preexisting BEA is a risk factor for formation of hepatic abscesses after RF ablation. An antibiotic prophylaxis regimen before the intervention and for a prolonged period after the intervention that covers anaerobic bacteria for at least 10 days is presented. Combined therapy of transarterial chemoembolization and RF ablation increases the risk for complications in patients with known BEA.

Abstract

PURPOSE: To reduce risk of development of a hepatic abscess in patients with preexisting bilioenteric anastomosis (BEA) undergoing radiofrequency (RF) ablation of hepatic tumors by use of prolonged antibiotic prophylaxis over at least 10 days.
MATERIALS AND METHODS: Between April 2003 and June 2011, 184 patients underwent 206 percutaneous RF ablation procedures for hepatic malignancies. Eight patients presented with BEA and were treated in 10 sessions at 14 tumor locations. These 8 patients were male and ranged in age from 55-73 years. Median follow-up was 34 months. Antibiotic prophylaxis was given before the intervention (n = 9, piperacillin/tazobactam; n = 1, ciprofloxacin). Oral antibiotic prophylaxis after the intervention was continued with ciprofloxacin for at least 10 days. In four cases, prophylaxis after the intervention was extended with additional antibiotics.
RESULTS: A liver abscess occurred 22 days after 1 of 10 RF ablation sessions in patients with preexisting BEA. The patient who developed an abscess presented with a large hepatocellular carcinoma (59 mm × 54 mm) and underwent transarterial chemoembolization 8 days before RF ablation. No hepatic abscess occurred after 196 RF ablation sessions in 176 patients without BEA.
CONCLUSIONS: Preexisting BEA is a risk factor for formation of hepatic abscesses after RF ablation. An antibiotic prophylaxis regimen before the intervention and for a prolonged period after the intervention that covers anaerobic bacteria for at least 10 days is presented. Combined therapy of transarterial chemoembolization and RF ablation increases the risk for complications in patients with known BEA.

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11 citations in Web of Science®
15 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Diagnostic and Interventional Radiology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2012
Deposited On:09 Nov 2012 10:33
Last Modified:05 Apr 2016 16:03
Publisher:Elsevier
ISSN:1051-0443
Publisher DOI:https://doi.org/10.1016/j.jvir.2011.12.025
PubMed ID:22365593

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